Healthcare Provider Details

I. General information

NPI: 1780677823
Provider Name (Legal Business Name): MLADEN SOLAR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 79TH ST
BROOKLYN NY
11209-3508
US

IV. Provider business mailing address

116 79TH ST
BROOKLYN NY
11209-3508
US

V. Phone/Fax

Practice location:
  • Phone: 718-745-4141
  • Fax: 718-680-0791
Mailing address:
  • Phone: 718-745-4141
  • Fax: 718-680-0791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number127918
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number127918
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: